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Expert Opin Drug Metab Toxicol. 2017 Jun;13(6):669-677. doi: 10.1080/17425255.2017.1312340. Epub 2017 Apr 3.

Management of precipitated opiate withdrawal syndrome induced by nalmefene mistakenly prescribed in opiate-dependent patients: a review for clinicians.

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a Service d'Addictologie , Centre Hospitalo-Universitaire Toulouse-Purpan , Toulouse , France.
b Centre Antipoison et de Toxicovigilance , Centre Hospitalo-Universitaire Toulouse-Purpan , Toulouse , France.
c Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1027 , Université Paul Sabatier , Toulouse , France.
d Département de Psychiatrie et d'Addictologie , Centre Hospitalo-Universitaire Lille , Lille , France.



Nalmefene, a long-acting µ-opioid antagonist approved to treat alcohol use disorder, is occasionally mistakenly prescribed to opiate-dependent or opioid-treated patients. We review recent literature on drug-drug interactions between nalmefene and opioids that lead to precipitated opioid withdrawal, and focus on its management and planning for care at discharge. Areas covered: This article provides a brief and comprehensive review of management of precipitated opioid withdrawal syndrome when nalmefene is associated with an opioid, whether misused or legally prescribed. Expert opinion: When treating an opiate-dependent patient with co-occurring alcohol use disorder, both conditions need to be a focus of clinical attention. New drugs for alcohol use disorder have been approved, but must be given cautiously and with a full understanding of their potential drug-drug interactions with opioid medications. Opiate-dependent patients should be intensively monitored for risk factors of alcohol use disorder and should be continuously motivated for treatment maintenance. When nalmefene is administered to opiate-dependent patients, acute opioid withdrawal syndrome may occur. Management of precipitated acute opioid withdrawal may include short or long-acting µ-opioid agonists during hospitalization, in addition to supportive treatment. The best management of polydrug abusers is based on a multidisciplinary approach, which should be pursued and improved through continuing medical education.


Addiction medicine; nalmefene; opioid maintenance therapy; precipitated opioid withdrawal

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